Ryan White and ACA: A Board Considers Change

Ryan White and ACA: A Board Considers Change

October 31, 2013

TARGET Center

Does the Affordable Care Act mean the Ryan White HIV/AIDS Program is going to go away?

A South Carolina HIV/AIDS clinic’s staff and board once had that expectation, as did many grantees and consumers around the country. That feeling—and fear—has since passed but it was nonetheless quite a motivator for South Carolina’s Catawba Care to engage in some strategic planning about the agency’s future. Catawba Care is a Ryan White Part A, B and C grantee in Rock Hill, located in the far southwest perimeter of the Charlotte metropolitan area. The staff members began contemplating what the Affordable Care Act would mean for them even before the legislation was enacted in 2010.

What services should they keep providing?

What source of funding will keep the doors open?

What opportunities are available to change things in order to better serve people living with HIV/AIDS?

Catawba is changing as are many other Ryan White agencies. Over the coming months, the TARGET Center is going to track the progress of Catawba Care and other Ryan White agencies as they modify their ways of doing business. We will share insights from various Ryan White grantees and highlight tools to help agencies adjust to ACA.

Contemplating Change

Agencies can take many paths in determining how to change their way of doing business, although the common theme of any response is to step back, contemplate, and assess various options. Catawba’s journey started with talking. Lots of talking. “People wished that I would shut up,” said Executive Director Anita Case. She wasn’t the only one talking. ACA was a constant topic at the quarterly meeting of Part B program directors. Indeed, the topic of preparing for change predated ACA, starting in 2009 with discussions that touched upon what was then the potential for health care reform along with topics such as how to take advantage of learning opportunities.

With passage of ACA, the pace picked up. In 2010, several consultants were invited to Catawba to talk about ACA and its potential impact on Ryan White. Strategic planning by the board started in 2010, with ACA being just one of multiple topics.

Becoming More Concrete

In 2011, with a planning grant from the HRSA Bureau of Primary Care, which manages the Health Centers program, the agency spent a year doing a needs assessment to see whether a second Health Center in the county would be useful. At a board retreat, Catawba looked at a range of options—from staying the same to merging and closing the agency’s operations as a free-standing HIV/AIDS clinic. (These options are outlined in Agency Options, a tool developed at Catawba that might be useful in guiding other agency board discussions.)

Driving the discussion in 2011 were concerns and questions such as: What if Ryan White goes away, funding is reduced significantly, or it stays the same? Should we change to a free-clinic model? What should be our fundraising goals for filling gaps in Ryan White funding?

In 2012, several consultants were brought in under the HRSA planning grant to discuss what it would mean if the agency became a Health Center, Federally Qualified Health Center, or a Look-Alike. The Duke Center for Health Policy & Inequalities Research completed a needs assessment. Results were shared at a 2012 retreat, along with a statewide perspective from the South Carolina Primary Care Association. "It was an ongoing conversation with the board, which eventually said, 'We are tired of talking about this and voted to table conversation until more information came out, pending reauthorization, funding, and guidance from HRSA,'" said Case.